Treatment of respiratory depression with the anticholinesterase drug galanthamine hydrobromide

Abstract

Galanthamine hydrobromide (Nivalin, Pharmachim,) is an alkaloidal derivative of Galanthus nivalis, the spring flower, 'snowdrop'. Chemically related to morphine, this anticholinesterase substance traverses the blood-brain barrier. Two groups in Bulgaria, Paskov, Dobrev & Nikiforov,' writing in 1964, and later Stoyanov & Statkov,2 reported on the ability of galanthamine hydrobromide to antagonise respiratory depression due to morphine and other euphoriates in animals. Wislicki3 reported clinical impressions of the effect of this drug on respiration of patients following anaesthesia in 1967 but a search in the available literature failed to reveal any reports of the use of galanthamine hydrobromide on other forms of depressed respiration in humans.Case report A 44-year-old retired army sergeant was brought to casualty at 00.40 hours on 11 December 1972, after having ingested a total of fifty tablets each containing methaqualone 250 mg and diphenhydramine 25 mg (Mandrax) and twenty-nine tablets of dextromoramide 5 mg (Palfium) some 20 minutes prior to admission.Physical examination revealed a pale, lean muscular male weighing 65 kg. Pupils were pin-point and symmetrical, extremities cold, and the rectal temperature measured 35.9"C. Systolic blood pressure was 80 mmHg and heart rate 1 lO/minute and regular. A midline laparotomy scar resulting from a pancreatic exploration in 1971 was noted. Tendon reflexes were diminished and symmetrical.The respiration ceased almost immediately after admission. An endotracheal tube was passed and ventilation (IPPV) begun with 100% oxygen via an Aga Revivator. An intravenous glucose 5% drip was started, atropine 0.5 mg was administered intravenously and a naso-gastric tube passed; a large quantity of yellow and white tablet mass was recovered. Gastric lavage was carried out, a urinary catheter was

Galantamine: A New Alzheimer Drug with a Past Life

“…One report 24 described a patient who had overdosed on a combination of methaqualone, diphenhydramine, and dextromoramide. The latter of these three agents is a chemical relative of methadone.…”

High-performance liquid chromatographic method with UV photodiode-array, fluorescence and mass spectrometric detection for simultaneous determination of galantamine and its phase I metabolites in biological samples

“…It is used in neuromuscular diseases such as myasthenia gravis [1], in antagonism of skeletal neuromuscular blockade [2] and drug-induced respiratory depression [3]. Galantamine was approved for the treatment of mild-to-moderate Alzheimer's disease [4].…”

Radioimmunoassay for the Quantitative Determination of Galanthamine

“…This phenanthrene alkaloid finds its clinical application as a potent natural cholinergic substance, showing strong anticholinesterase activity (5-9). In addition, this compound shows analeptic effects (10) and can be used to treat Alzheimer's disease (11). Galanthamine HBr is available for medical treatment as Nivalin [Pharmachim (Sofia, Bulgaria)] and Galanthamine [Medex-port (Moscow, USSR)I.…”